Systems and methods for fabricating a dental template

ABSTRACT

A dental template to position an object on a patient&#39;s tooth includes digitizing the patient&#39;s tooth; adding virtual objects to predetermined locations on the digitized tooth; and fabricating the dental template to locate the object on the patient&#39;s tooth. The template can be used for etching or for positioning brackets on teeth.

CROSS-REFERENCE

The present application is a Continuation of U.S. application Ser. No.13/620,209, filed on Sep. 14, 2012, which is a Continuation of U.S.application Ser. No. 11/297,129, filed on Dec. 7, 2005, now U.S. Pat.No. 8,496,473, which is a Continuation of U.S. application Ser. No.10/870,808, filed on Jun. 17, 2004, now U.S. Pat. No. 7,056,115, whichis a Continuation of U.S. application Ser. No. 10/375,223, filed on Feb.26, 2003, the full disclosures of which are incorporated herein byreference.

BACKGROUND OF THE INVENTION

The present invention relates generally to the field of orthodontics.

One objective in orthodontics is to move a patient's teeth to a positionwhere the teeth function optimally and are also aesthetically pleasing.Conventional appliances such as braces and wires can be positioned on apatient's teeth by a treatment provider such as an orthodontist or asuitably trained dentist. Once mounted on the teeth, the hardware exertscontinual forces on the teeth and gradually urges the teeth toward theirideal positions. Over a period of time, the treatment provider adjuststhe braces and the wires to move the teeth toward their finaldestination.

Orthodontic brackets are often bonded directly to the patient's teeth.Typically, a small quantity of adhesive is placed on the base of eachbracket and the bracket is then placed on a selected tooth. Before theadhesive is set, the bracket is maneuvered to a desired location on thetooth. Once the adhesive has hardened, the bracket is bonded to thetooth with sufficient strength to withstand subsequent orthodonticforces as treatment progresses. One shortcoming with this technique isthe difficulty in accessing the optimal surface for bracket placement onseverely crowded teeth or in teeth where the bonding surface isobstructed by teeth in the opposing arch during jaw closure. Withposterior teeth, the treatment provider may have difficulty seeing theprecise position of the bracket relative to the tooth surface. Theamount of time needed to carry out the bonding procedure may be anuisance both to the patient as well as to the treatment provider. Also,the necessity of minimizing moisture contamination from the patient'ssaliva can prolong the procedure and also unduly impair the accuracy ofplacement of the brackets on the teeth. All of these factors increasethe chance that the ultimate adhesive bond will not have sufficientstrength to retain the brackets on the teeth during treatment. One wayto overcome some of the limitations of direct bracket placement is withindirect bonding. Typically, an impression of each of the patient'sdental arches is taken and a replica plaster or “stone” model is madefrom each impression and sealed. Brackets are bonded to the sealed stonemodels using a temporary cement. A transfer tray is then made by placingmatrix material over both the model and the brackets on the model. Forexample, a heated plastic sheet matrix material may be placed over themodel and brackets and then under pressure. The plastic sheet materialthen assumes a configuration that precisely matches the shape of thereplica teeth of the stone model with the brackets in the desiredposition. The plastic material is then allowed to cool and harden toform a tray. The temporary adhesive is removed, permanent adhesive isplaced on the base of each bracket in the tray, and the tray with theembedded brackets then placed over matching portions of the patient'sdental arches. Since the configuration of the interior surface of thetray closely matches the respective portions of the patient's dentalarches, each bracket is ultimately positioned on the patient's teeth atprecisely the same location that corresponds to the previous location ofthe same bracket on the stone model. The adhesive is hardened and thematrix material removed, leaving the brackets in the desired positions.This method however, is labor intensive. An additional problem with theindirect method is that brackets may become dislodged during the removalof the matrix from the dental arches. The problem of proper access totooth surfaces for optimal placement in the event of severely crookedteeth or teeth which interfere with the opposing arch such that bracketscannot be placed is also not addressed.

New methods such as those described in U.S. Pat. No. 5,975,893, commonlyassigned to the assignee of the instant invention, allow the treatmentto be planned in advance and a plurality of polymeric shell appliancesare fabricated at the outset of treatment. The use of polymeric shellappliances provides treatments that are more comfortable; less visible,and removable by the patient, and greatly improves patient compliance,comfort, and satisfaction.

Since each patient is unique and requires customized treatment, onoccasion, a patient may need to utilize a combination of braces/wiresand shell appliances. Ideally, a device would enable precise placementof brackets on teeth with minimal risk of displacing the brackets uponremoval of the matrix and allow final placement to be independent ofadjacent geometries. In other words, placement of obscured toothsurfaces may be accomplished at a later time when the tooth surfaceshave been exposed through initial uncrowding of severely overlappedteeth.

SUMMARY OF THE INVENTION

A dental template is disclosed to support positioning an object on apatient's tooth oriented in such a way that all the objects as a wholeare lined up to a user defined ideal arrangement. Also, a method isdisclosed for fabricating the template. The method includes digitizingthe patient's teeth; adding virtual objects to predetermined locationson the digitized teeth; and fabricating the dental template to locatethe object on the patient's teeth.

Advantages of the template may include one or more of the following. Thetemplate can be used for etching or for positioning brackets on teeth.The treatment can be done virtually and the placement of the bracketscan be done using a template device that is a removable guide. Thisdevice allows precise placement of the bracket and enables bracketplacement onto specific teeth independent of overall arch geometry. Thetemplate makes it easier for a less well-trained or an untrained personto bond a bracket. The system minimizes variations in the perception ofdistance and angles. The template provides a very precise control on theplacement of the bracket. Since bracket placement is one of the criticalvariables to successful treatment, the template improves treatmentprecision from patient to patient and from tooth to tooth.

The device itself may not necessarily contain the bracket as withtraditional indirect bonding (IDB) templates, but rather, directs theuser as to the precise location where the bracket should be placed basedon geometric fit.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 shows an exemplary method or process to fabricate a dentaltemplate to position an object on a patient's tooth.

FIG. 2A shows an exemplary method or process for placing an orthodonticobject on a patient's tooth.

FIG. 2B shows a second method of placing the orthodontic object on apatient's tooth.

FIG. 3A illustrates an exemplary process for fabricating the dentaltemplate.

FIG. 3B shows a process for providing four possible templates.

FIGS. 4A-4D show perspective views of various templates.

FIGS. 5A and 5B illustrate two embodiments of articulated templates.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 shows an exemplary method or process to fabricate a dentaltemplate to position an object on a patient's tooth. First, the processdigitizes the patient's tooth (10). Next, virtual objects are added topre-determined locations on the digitized tooth (12). Finally, theprocess fabricates the dental template to locate the object on thepatient's tooth (14). One detailed implementation of FIG. 1 is describedin FIGS. 3A and 3B below.

FIG. 2A shows an exemplary method or process for placing an orthodonticobject on a patient's tooth. The process uses the template fabricated inthe process of FIG. 1. The process includes placing the template on thepatient's teeth (20); mounting the orthodontic object between thetemplate and the tooth (22); and bonding the orthodontic object to thetooth (24). In the bonding operation, chemical curing or light curingadhesives can be used. In chemical curing, separately supplied curingcomponents are mixed together and a small quantity of the mixture isplaced on the back of the bracket prior to placing the bracket on thetooth. Light-curable adhesives include a photo-initiator that initiatesthe curing reaction once the adhesive is exposed to a sufficient amountof light. A common method of using light-curable adhesives for directbonding includes the steps of placing a small quantity of the adhesiveon the base of the bracket and then placing the bracket on the patient'stooth. The practitioner then shifts the bracket on the tooth as may beneeded. Once the bracket is in its precise, intended location, lightfrom a dental curing unit is directed toward the adhesive for a timeperiod sufficient to satisfactorily cure the adhesive.

FIG. 2B shows a second method of placing the orthodontic object on apatient's tooth. In this process, the orthodontic object is placed inthe template (30). Next, the process includes inserting the templatecontaining the orthodontic object onto the patient's teeth (32).Finally, the process includes bonding the orthodontic object to thetooth (34).

FIG. 3A illustrates an exemplary process for fabricating the dentaltemplate. First, a digital model of a patient's teeth of a patient isobtained (102). The digital model can be obtained in a variety of ways.For example, the patient's teeth may be scanned or imaged using wellknown technology, such as X-rays, three-dimensional x-rays,computer-aided tomographic images or data sets, magnetic resonanceimages, etc. There are a variety of range acquisition systems, generallycategorized by whether the process of acquisition requires contact withthe three dimensional object. A contact-type range acquisition systemutilizes a probe, having multiple degrees of translational and/orrotational freedom. By recording the physical displacement of the probeas it is drawn across the sample surface, a computer-readablerepresentation of the sample object is made. A non-contact-type rangeacquisition device can be either a reflective-type or transmissive-typesystem. There are a variety of reflective systems in use. Some of thesereflective systems utilize non-optical incident energy sources such asmicrowave radar or sonar. Others utilize optical energy. Thosenon-contact-type systems working by reflected optical energy furthercontain special instrumentation configured to permit certain measuringtechniques to be performed (e.g., imaging radar, triangulation andinterferometry).

Next, virtual brackets are selected (104). The virtual brackets are 3Dmodels of existing brackets. The 3D models may be a computer aideddesign (CAD) model or may be scanned using scanners described above. Thebrackets may be positioned on a digitized tooth using a computer orworkstation having a suitable graphical user interface (GUI) andsoftware appropriate for viewing and modifying the images. Theabove-described component identification and component manipulationsoftware is designed to operate at sophistication commensurate with theoperator's training level. For example, the component manipulationsoftware can assist a computer operator, lacking orthodontic training,by providing feedback regarding permissible and forbidden manipulationsof the teeth. On the other hand, an orthodontist, having greater skillin intra-oral physiology and teeth-moving dynamics, can simply use thecomponent identification and manipulation software as a tool and disableor otherwise ignore the advice.

While the methods will rely on computer manipulation of digital data,the dental templates or appliance may be produced by non-computer-aidedtechniques. For example, plaster casts obtained as described above maybe cut using knives, saws, or other cutting tools in order to permitrepositioning of individual teeth within the casting. The disconnectedteeth may then be held in place by soft wax or other malleable material,and a plurality of intermediate tooth arrangements can then be preparedusing such a modified plaster casting of the patient's teeth. Thedifferent arrangements can be used to prepare the template usingpressure and vacuum molding techniques. While such manual creation ofthe appliance systems of the present invention will generally be muchless preferred, systems so produced will come within the scope of thepresent invention.

Using the CAD workstation, a combined digital model of the virtualbrackets and the teeth is produced (106).

In one implementation, four template embodiments can be selected:Direct-Articulated, Indirect-Articulated, Direct-Unified, andIndirect-Unified, as discussed in more detail in FIG. 3B.

Once the template has been fabricated, in one embodiment, the systemsets the template over the model of the patient's arches or otherwisepositions the template in the approximate locations of their respectiveteeth. A thermoformed, cast, or otherwise formed layer of flexiblematerial is deposited on the bodies. The layer makes intimate andrelatively durable contact with the bodies of the templates. This may beaccomplished, among other ways, by adding or subtracting geometries tothe bodies to engage well with the material layer. This method could beperformed either by a factory or in the orthodontist's office.

The system produces both the template bodies and the inter-toothportion(s) at the same time and subsequently alter the stiffness of thevarious parts. One way of achieving this would be to produce the entirearch with a 3-D printer, mask the tooth bodies from the inter-toothportions, embed the tooth bodies with a rigidifying agent and theinter-tooth portions with an agent to create flexibility.

From 110, if a directly formed template is produced, the processproceeds to 114 where each tooth is scaled; a cavity is formed toenclose the tooth when the dental template or appliance is inserted overthe patient's teeth. Next, unnecessary structures are removed from thedigital model. The digital model is produced as a physical model. Aflexible pliable layer is formed and the resulting combination istrimmed to allow proper fit and function.

Alternatively, from 110 if indirect forming is to be done, the processforms and aligner, and cuts and removes excess material (112).

From 108, for direct fabrication of a template of a whole arch (116)using an indirectly-produced template, the process forms an aligner,cuts and removes excess material (118). In the case of a directly formedwhole arch template (116), the process proceeds to 120 where the entirearch is scaled; a cavity is formed to enclose the arch when the dentaltemplate or appliance is inserted over the patient's teeth. Next,unnecessary structures are removed from the digital model. The digitalmodel is produced as a physical model. A flexible pliable layer isformed and the resulting combination is trimmed to allow proper fit andfunction.

FIG. 3B shows a process for providing four possible templates. First,the process acquires a digital model of dentition, adds virtual bracketsto teeth, and creates a combined model (180). Next, one of fourtemplates options can be selected. The first option is unified (orsingle piece)-direct bonding option where the process scales the arch(est. 105-150%), locates original arch and scaled arch in same 3D space,creates cavity of original inside scaled arch, removes gingivalportions, substantial part of lingual tooth surfaces, buccogingivalsurfaces covering virtual brackets, and produces real arch model fromdigital model (182).

In the second option (unified indirect bonding), the process producesreal arch model from digital model and forms a removable appliance(aligner) template on real model of arch. The template is removed fromthe real model, and the process then removes gingival portions,substantial part of lingual tooth surfaces, buccogingival surfacescovering virtual brackets (184).

In the third option (articulated direct bonding), the process scalesindividual tooth (est. 105-150%), locates each original tooth and itsscaled version in same 3D space, creates a cavity of each originalinside its scaled version, removes gingival portions, substantial partof lingual tooth surfaces, buccogingival surfaces covering virtualbrackets, produces real tooth models from digital models, positionsteeth in appropriate locations and orientations, forms a flexible orpliable material over teeth, and trims excess material from the template(186).

In the fourth option (articulated indirect bonding), the process formsan aligner-like template on a mold of an arch. The template is removedfrom the mold and gingival portions, substantial part of lingual toothsurfaces and buccogingival surface covering virtual brackets aretrimmed. The process cuts an arch template onto an individual tooth. Aflexible or pliable layer over the template is formed, and excessmaterial is trimmed (188).

In yet another embodiment, a process obtains tooth geometries. If directbonding is to be used, the process performs the following:

-   -   Scale the arch to a value likely within the range 105-150%.    -   Co-locate the original (100%) arch and the scaled arch in the        same 3D space    -   Place a virtual bracket or other appropriate geometry at a        specific location and in a specific orientation on each tooth to        be treated.    -   Cavity the original arch and the brackets in the scaled arch.    -   Remove from the resulting template or body those aspects that        would be below the gingival line. Remove the portions of the        resultant body buccal and gingival to the brackets remove a        substantial portion or all of the lingual aspect of the        resultant body.    -   Convert this computer model to a real part, likely through the        use of a rapid prototyping method (e.g. Fused Deposition        Modeling, 3-D Printing, stereolithography).

If indirect bonding is to be done, the following operations are doneusing an arch model:

-   -   Form an Aligner-like appliance or template over an arch model        that has brackets or other appropriate geometries properly        located on the teeth.    -   Remove from the Aligner or template those aspects that would be        below the gingival line or in direct interproximal contact with        adjacent teeth. Remove the portions of the Aligner buccal and        gingival to the bracket. Remove a substantial portion or all of        the lingual aspect of the Aligner.

After completion, the process ships the templates, bodies or thecompleted appliance to the orthodontist either at the onset of treatmentor when it is requested.

FIG. 4A shows one embodiment of a dental template 220 or applianceformed over a mold 210. The template looks like a removable appliance;however, it has openings 222 or “port-holes” approximating thefootprint, key portions of the footprint, and/or possibly othergeometrical features of a bracket to guide the precise placement of thebracket on its respective tooth. The template 220 with the openings 222or “port-holes” may also be a guide for enamel etching or adhesiveplacement.

The mold 210 is a physical rendition of a digital model that has beenfabricated using rapid prototyping methods. A bump or projection 212rises from the mold 210 so when the dental template or appliance isthermal-formed, an opening 222 is formed on the template 220. Theopening 222 is where the template is cut out along the edge of the bumpor projection 212. The opening 222 has a bracket support edge 226, whoseoperation is described in more detail in FIG. 4B. In addition to thesupport edge 226, the template 220 may have features that will minimizethe retention of it on the dental anatomy. For example, the lingual sideof the device may not have maximum coverage.

Fabrication methods for the mold 210 employ a rapid prototyping devicesuch as a stereolithography machine or a fused deposition modelingmachine. A suitable rapid prototyping machine is Model SLA-250/50available from 3D System, Valencia, Calif. The rapid prototyping machineselectively hardens a liquid or other non-hardened resin into athree-dimensional structure, which can be separated from the remainingnon-hardened resin, washed, and used either directly as the appliance orindirectly as a mold for producing the appliance. The prototypingmachine receives the individual digital data sets and produces onestructure corresponding to each of the desired appliances. Generally,because the stereolithography machine may utilize a resin havingnon-optimum mechanical properties and which may not be generallyacceptable for patient use, the prototyping machine produces the mold210. After the positive model is prepared, a conventional pressure orvacuum molding machine may be used to produce the appliances from a moresuitable material, such as 0.03 inch thermal forming dental material,available from Tru-Tain Plastics, Rochester, Minn. 55902. Suitablepressure molding equipment is available under the trade name BIOSTARfrom Great Lakes Orthodontics, Ltd., Tonawanda, N.Y. 14150. The moldingmachine produces each of the appliances directly from the positive toothmodel and the desired material. Suitable vacuum molding machines areavailable from Raintree Essix, Inc.

In one embodiment, the template is made from a thick material (forexample 0.03 inches or more) to provide the user with more guidance inthe depth direction. Furthermore, the thick template allows easierlining the bracket to the tooth.

More information on the fabrication of the dental template or applianceis disclosed in U.S. Pat. No. 6,499,997 “Manipulable dental model systemfor fabrication of a dental appliance”; U.S. Pat. No. 6,497,574“Modified tooth positioning appliances and methods and systems for theirmanufacture”; U.S. Pat. No. 6,488,499 “Methods for correcting deviationsin preplanned tooth rearrangements”; U.S. Pat. No. 6,485,298 “System andmethod for releasing tooth positioning appliances”; U.S. Pat. No.6,471,511 “Defining tooth-moving appliances computationally”; U.S. Pat.No. 6,463,344 “Efficient data representation of teeth model”; U.S. Pat.No. 6,457,972 “System for determining final position of teeth”; U.S.Pat. No. 6,454,565 “Systems and methods for varying elastic modulusappliances”; U.S. Pat. No. 6,450,807 “System and method for positioningteeth”; U.S. Pat. No. 6,409,504 “Manipulating a digital dentition modelto form models of individual dentition components”; U.S. Pat. No.6,406,292 “System for determining final position of teeth”; U.S. Pat.No. 6,398,548 “Method and system for incrementally moving teeth”; U.S.Pat. No. 6,394,801 “Manipulable dental model system for fabrication ofdental appliances”; U.S. Pat. No. 6,390,812 “System and method forreleasing tooth positioning appliances”; U.S. Pat. No. 6,386,878“Systems and methods for removing gingiva from teeth”; U.S. Pat. No.6,386,864 “Stress indicators for tooth positioning appliances”; U.S.Pat. No. 6,371,761 “Flexible plane for separating teeth models”; U.S.Pat. No. 6,318,994 “Tooth path treatment plan”; U.S. Pat. No. 6,309,215“Attachment devices and method for a dental appliance”; U.S. Pat. No.6,299,440 “System and method for producing tooth movement”; U.S. Pat.No. 6,227,851 “Manipulable dental model system for fabrication of adental appliance”; U.S. Pat. No. 6,227,850 “Teeth viewing system”; U.S.Pat. No. 6,217,325 “Method and system for incrementally moving teeth”;U.S. Pat. No. 6,210,162 “Creating a positive mold of a patient'sdentition for use in forming an orthodontic appliance”; and U.S. Pat.No. 5,975,893 “Method and system for incrementally moving teeth,” thecontents of which are hereby incorporated by reference.

Turning now to FIG. 4B, the template 220 is separated from the mold 210.The opening 222 allows a bracket base to fit into the opening 222.Bracket support edge 226 is needed to securely position the bracket inthe template 220. In this embodiment, the bracket support edge 226 iscurvaceous. If the edge 226 had been terminated as a simple flat edge,the bracket can be located in X and Y surfaces on the tooth, but the Zdirection (buccal lingual direction) would not be controlled. The edge226 provides the needed control of the bracket's degree of freedom inthe Z direction to allow orientation of the bracket about any givenaxis. Those features allow the bracket to be secured in the properposition and orientation on its respective tooth. The edge 226 canchange, depending on vendor-to-vendor or prescription-to-prescription.

Another embodiment of the template can be used for etching bondingchemicals on the patient's teeth. The etching template directs the userto predetermined locations on the teeth surfaces that need to be bonded.The etching template can be either the format of a windowed template ora concave surfaced template where bonding gel is loaded or pre-loadedinto the concavity.

FIG. 4C shows a template wherein each of the openings, cut-outs,port-holes, or slots 222 in the template 220 are designed to fitparticular brackets 4A, 4B and a 4C, each of which fits into itsrespective portion on the template.

FIG. 4D shows that the system is not limited to bracket design or shape.In FIG. 4D, a molar tube bracket 215 can be placed on the opening 222.Hence, the template 220 is not limited to any specific bracket. Rather,any form of fixed orthodontic appliances placed on a tooth could beaccommodated.

FIGS. 5A and 5B illustrate two exemplary embodiments of articulatedtemplates. FIG. 5A shows two segments joined at the interproximalregions of two adjacent teeth. A number of alternate methods to join theteeth can be used, including that the joining methods could be alternateor vary from one interproximal region to the next. Further, the joiningmethod could also be a layer or layers that cover additional ordifferent surfaces of the teeth as depicted in FIG. 5B.

In FIG. 5A, the template is made up of a number of movable templatecomponents 250. Each of the template components 250 can be mounted on apatient's tooth to facilitate bracket bonding. The movable templatecomponents 250 are physically linked together by a sheet of material 252deposited above the components 250 so that they do not break-up orotherwise become disassembled upon removal from its mold orstereolithography apparatus (SLA) model. The articulated templates areadvantageous in that they provide greater adjustment flexibility.

The template can additionally be used as an etching template. An etchingtemplate allows the doctor to precisely etch the areas of the teeth onwhich the brackets will be placed. The small windows bound the regionsthat will be etched to minimize teeth sensitivity to etching or unwantedenamel removal. In another version of the etching template, the cut outswould not be formed. Instead those areas would be concavities facing thetooth surfaces. These concavities would contain an etching compound. Theuser would expose or activate the etching compound prior to setting thetemplate on the teeth.

The template 220 may be made from materials that contain physicalproperty switches for ease of removal. These switches might includetemperature responsive, pH responsive, moisture responsive or amulti-layer system wherein the layers have varying physical properties.The section 500 represents a flexible or pliable material. Additionally,the material could be fiber, cord, fiber mesh, or a fiber-reinforcedsolid. The interproximal material can be homogenous or heterogeneous.

Various alternatives, modifications, and equivalents may be used in lieuof the above components. Additionally, the techniques described here maybe implemented in hardware or software, or a combination of the two. Thetechniques may be implemented in computer programs executing onprogrammable computers that each includes a processor, a storage mediumreadable by the processor (including volatile and nonvolatile memoryand/or storage elements), and suitable input and output devices. Programcode is applied to data entered using an input device to perform thefunctions described and to generate output information. The outputinformation is applied to one or more output devices. Each program canbe implemented in a high level procedural or object-oriented programminglanguage to operate in conjunction with a computer system. However, theprograms can be implemented in assembly or machine language, if desired.In any case, the language may be a compiled or interpreted language.Each such computer program can be stored on a storage medium or device(e.g., CD-ROM, hard disk or magnetic diskette) that is readable by ageneral or special purpose programmable computer for configuring andoperating the computer when the storage medium or device is read by thecomputer to perform the procedures described. The system also may beimplemented as a computer-readable storage medium, configured with acomputer program, where the storage medium so configured causes acomputer to operate in a specific and predefined manner. Further, whilethe invention has been shown and described with reference to anembodiment thereof, those skilled in the art will understand that theabove and other changes in form and detail may be made without departingfrom the spirit and scope of the following claims.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments of the invention describedherein may be employed in practicing the invention. It is intended thatthe following claims define the scope of the invention and that methodsand structures within the scope of these claims and their equivalents becovered thereby.

What is claimed is:
 1. A system for positioning a plurality oforthodontic objects on a patient's teeth, comprising: a computer system;and a template adapted for placement over the teeth so as to fit on andspan a plurality of the patient's teeth, the template comprising aninner teeth facing surface adapted to be positioned adjacent to thepatient's teeth and an outer surface away from the inner teeth facingsurface, the inner teeth facing surface defining a plurality of teethreceiving cavities, each cavity shaped based on a digital teeth model ofthe patient's teeth made using the computer system, such that eachreceived tooth geometrically fits within one of the plurality of teethreceiving cavities; wherein the computer system is configured withinstructions to display a plurality of virtual orthodontic objectsplaced at specific locations and orientations on the digital teethmodel, the template further comprising one or more openings, eachcomprising a cut-out that is open to a gingival side of the template,the cut-out defining an orthodontic object support edge shaped to allowan orthodontic object base to fit directly into the opening to positionan orthodontic object in the template and wherein the template comprisesa plurality of orthodontic objects placed at the specific locations andorientations of the plurality of virtual orthodontic objects on thedigital teeth model.
 2. A system as in claim 1, wherein the templatecomprises a directly fabricated articulable shell with a plurality offlexibly linked cavities.
 3. A system as in claim 1, wherein thetemplate comprises a non-articulated template fabricated directly fromthe digital teeth model.
 4. A system as in claim 1, wherein the templateis formed by a process comprising: generating a template model based onthe digital teeth model; and generating the template based on thetemplate model.
 5. A system as in claim 1, wherein the one or moreopenings comprise a rounded edge for positioning of a bracket.
 6. Asystem as in claim 1, wherein a thickness of the template is at least0.03 inches in a buccal-lingual direction.
 7. A system as in claim 1,wherein the template is made from a variable physical material having afirst state for retention of the template on the patient's teeth and asecond state for facilitating removal of the template from the patient'steeth.
 8. A system as in claim 1, wherein the template is articulated.9. A system as in claim 1, wherein the template is unified.
 10. A systemas in claim 1, wherein the outer surface is larger than the inner teethfacing surface by an amount, the amount within a range between about105% to about 150% of the inner teeth facing surface.
 11. A system as inclaim 1, wherein the template comprises a plurality of movable templatecomponents linked together with a flexible material.
 12. A system as inclaim 1, wherein the template comprises a plurality of articulatedsegments linked together with a flexible material.